Individual & Consumer Plans are health insurance policies that you purchase for yourself or your family if you do not have access to employer-sponsored coverage or other health care programs. These plans can provide a range of benefits, including doctor visits, hospital stays, prescription drugs, and preventive care.
Frequently Asked Questions
Research common questions on health plan and coverage options. If you have questions not featured below, please write us.
Individual & Consumer Plans
Who is eligible to enroll in Individual & Consumer Plans?
Eligibility typically includes anyone who is not covered by an employer-sponsored plan, Medicare, Medicaid, or another public health insurance program. You must be a U.S. citizen, national, or lawfully present in the U.S., and live in the state where you are applying for coverage.
What types of financial assistance are available for Individual & Consumer Plans?
You may qualify for premium tax credits, cost-sharing reductions, and state subsidies like the New Jersey Health Plan Savings. These financial aids help lower your monthly premiums and out-of-pocket costs.
How can I apply for an Individual & Consumer Plan?
You can apply online through the health insurance marketplace, over the phone, by mail, or in person with the help of a certified assister or broker.
What documents do I need to apply for an Individual & Consumer Plan?
You will need personal information such as home and mailing addresses, birth dates, Social Security numbers, immigration documents (if applicable), and employer and income information for all household members applying for coverage. Prepare for your consultation
Medicare Plans
What are Medicare Plans?
Medicare is a federal health insurance program for people aged 65 or older, some younger people with disabilities, and those with End-Stage Renal Disease. It includes Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
Who is eligible for Medicare?
Generally, people aged 65 or older, individuals under 65 with certain disabilities, and people of any age with End-Stage Renal Disease are eligible for Medicare.
How do I enroll in a Medicare Plan?
You can enroll in Medicare through the Social Security Administration website, by phone, or by visiting your local Social Security office. You may also get assistance from a Medicare specialist.
What is the difference between Original Medicare and Medicare Advantage Plans?
Original Medicare includes Part A and Part B, covering hospital and medical services. Medicare Advantage Plans (Part C) are an alternative that includes all benefits of Part A and Part B, often with additional coverage like dental, vision, and prescription drugs.
Can I have both Medicare and Medicaid?
Yes, if you qualify for both, you can be enrolled in both Medicare and Medicaid, known as dual eligibility.
What is Medigap?
Medigap, or Medicare Supplement Insurance, helps cover costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.
How do I choose the right Medicare plan?
Our experts will help you compare your options based on your healthcare needs and financial situation.
Can I change my Medicare plan?
Yes, you can change your plan during the Annual Enrollment Period (AEP) or if you qualify for a Special Enrollment Period (SEP).
What are Medicare Savings Programs?
These programs help low-income individuals pay for some of their Medicare costs, including premiums, deductibles, and coinsurance.
How can I get help with prescription drug costs?
Medicare Part D offers prescription drug coverage, and Extra Help is available for those who qualify based on income and resources.
Are there additional costs with Medicare Plans?
Yes, while Part A is usually premium-free, Part B requires a monthly premium. Medicare Advantage and Part D plans may have additional premiums, co-pays, and deductibles.
Small Business Health Solutions
What are Small Business Health Insurance Plans?
Small Business Health Insurance Plans are designed for companies with up to 50 employees. These plans provide health coverage for employees and may include additional benefits like dental and vision insurance.
Who is eligible to purchase Small Business Health Insurance?
Small businesses with 1-50 full-time employees, including non-profit organizations, are eligible to purchase these plans.
What are the benefits of offering health insurance to employees?
Providing health insurance helps attract and retain employees, improves job satisfaction, and may offer tax benefits for the business.
How can a small business apply for health insurance?
Small businesses can apply through the Small Business Health Options Program (SHOP) Marketplace, directly through insurance carriers, or with the assistance of a broker.
Is there financial assistance available for small businesses offering health insurance?
Yes, businesses with fewer than 25 full-time employees may qualify for the Small Business Health Care Tax Credit if they offer SHOP coverage and meet certain criteria.
Dental & Vision Health Plans
What are Dental & Vision Plans?
Dental & Vision Plans are insurance policies that specifically cover dental and vision care, such as routine check-ups, eyeglasses, dental cleanings, and more advanced procedures.
What does a typical Dental Plan cover?
Dental plans often cover preventive services (like cleanings and exams), basic services (like fillings), and major services (like root canals and crowns). Coverage levels and out-of-pocket costs vary by plan.
What does a typical Vision Plan cover?
Vision plans usually cover eye exams, glasses, contact lenses, and sometimes discounts on corrective surgery. The extent of coverage varies by plan.
Can I purchase Dental & Vision Plans separately from health insurance?
Yes, dental and vision plans can be purchased separately if they are not included in your health insurance plan. This can provide additional benefits and cost savings for those who need it.